Perm Medical Journal

”Perm Medical Journal” (ISSN Key title: Permskiĭ medit︠s︡inskiĭ zhurnal) is a referred scientific and practical journal. It was founded in 1923 by Medical Society of Perm University. Since 2001 the founders of “Perm Medical Journal” are Perm State Academy of Medicine and Perm Research Center of Russian Academy of Medicl Sciences and Administration of Perm Region. Since 2017, the founder is Academician E.A. Vagner Perm State Medical University.

The journal is registered by the Roskomnadzor agency (licensee ЭЛ № ФС 77-75489 on 05.04.2019).

“Perm Medical Journal” is included into the list of the leading scientific journals and editions of the Russian Federation intended for publication of basic scientific results of theses for a degree of Doctor of Science.

01.14.01 - Obstetrics and gynecology (medical sciences)
01.14.02 - Endocrinology (medical sciences)
01.14.08 - Pediatrics (medical sciences)
01.14.12 - Oncology (medical sciences)
01.14.17 - Surgery (medical sciences)
01.14.25 - Pulmonology (medical sciences)
02.14.02 - Epidemiology (medical sciences)
03.14.09 - Clinical immunology, allergology (medical sciences)
03.14.10 - Clinical laboratory diagnostics (medical sciences)

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Vol 37, No 4 (2020)

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Original studies
Presence and absence of carbohydrate metabolism disorders as a factor influencing development of vitamin B12 deficiency
Guseinova A.R.
Abstract

Objective. To study the significance of the presence and absence of carbohydrate metabolism disorders as a factor affecting the development of vitamin B12 deficiency.

Materials and methods. The data of 206 subjects, forming two main groups were analyzed: the group of carbohydrate metabolism disorders (CMDs), which included 76 women and 71 men (n = 147); the control group, which included 33 women and 26 men (n = 59). The inclusion criteria were the following: age over 35, availability of anamnestic data on pharmacotherapy, availability of data to clarify the state of carbohydrate metabolism, availability of data on vitamin B12 and some other biochemical indices. Vitamin B12 levels > 221 pmol / l were considered normal, vitamin B12 levels from 148 pmol / l to 221 pmol/l were considered borderline (or mild deficiency), and levels of 148 pmol / l or less were considered severe vitamin B12 deficiency.

Results. The group of absent carbohydrate metabolism disorders included 59 persons and the group of carbohydrate metabolism disorders (CMDs) included T2DM patients (n = 123) and individuals with prediabetes (n = 24), i.e. the total number of the examined persons in CMD group was equal to 147. The average level of vitamin B12 in the control group (n = 59) was 401.6 ± and 138.06 pmol / l, and in CMD group (n = 147) it was equal to 342.1 ± 133.10 pmol/l. The differences between the groups were statistically significant (p < 0.01), that suggested the significance of CMDs as a risk factor for vitamin B12 deficiency. Vitamin B12 deficiency was combined with the presence of CMDs in 32 (21.8 %) cases. In 115 cases (78.2 %), the presence of CMDs was combined with the absence of vitamin B12 deficiency. In 8 cases (13.5 %), there were no CMDs, but there was vitamin B12 deficiency. In 51 cases (86.4 %), no CMDs and vitamin B12 deficiency was noted.

Conclusions. Despite the presence of a statistically significant decrease in vitamin B12 levels in CMD group (342.1 ± 133.10 pmol / l vs 401.6 ± and 138.06 pmol/ l; p < 0.01) and a high incidence rate of vitamin B12 deficiency in CMD group (21.8 % and 13.5 %, respectively), the study results do not allow us to consider the presence of CMDs to be the risk factor for vitamin B12 deficiency.

Perm Medical Journal. 2020;37(4):5-10
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Paramedic’s involvement in treatment and diagnosis of opisthorchiasis in conditions of paramedical and obstetric center
Gorshkov A.Y., Filatova L.P.
Abstract

Objective.Since the territory of Surgut and Surgut region is an opisthorchiasis hyperendemic zone and economically attractive for migrants, it is important to focus on the questions connected with early diagnosis and effective preventive activities aimed at increase of paramedic’s awareness of helminthiasis, especially those working at Paramedical and Obstetric Center.

Enhancement of diagnostic and preventive measures, refresher courses for paramedical personnel will optimize paramedic’s activity and reduce the risk for biohelminthosis infestation among the population living in hyperendemic zone. Enhancement of pandemic’s activity in case of population infestation with Opisthorchis felineus.

Materials and methods. One thousand patients, diagnosed opisthorchiasis were examined: 518 able-bodied women (52 %) and 482 men (48 %) aged 18–69. All the patients had a severe form of opisthorchiais. Reliability of results was proved using Fisher and Pearson’s correlation criteria.

Results. An assumption has been made regarding the existence of similarity between B antigens (III) blood group and opisthorchid antigens. Patients with B (III) and O (I) blood groups are the least resistant to parasitosis in comparison with the persons of other blood groups. The research allowed to distinguish two groups: more vulnerable B (III) and O (I) blood groups and less vulnerable А (II) и АВ (IV) blood groups, the owners of which are infected with helminthiasis more often and rarely, respectively.

Conclusions. Epidemic situation regarding opisthorchiasis in Surgut and Surgut region has been unfavorable for the recent several years. It is proved by high infestation of the population during the analyzed period of 2017–2019, i.e. 142.5 and 147.7 per 100 000 population, respectively. Correlation between blood groups, age and gender characteristics was determined. Analysis of paramedic’s activity at Paramedical and Obstetric Center showed that blood groups need to be taken into account in diagnosis of opisthorchiasis. The test for estimating risk of opisthorchiasis infestation was prepared.

Perm Medical Journal. 2020;37(4):11-16
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Evaluation of effectiveness of thioctic acid use in combined therapy of angiodistonia and polyneuropathy syndrome
Malyutina N.N., Bolotova A.F., Eremeev R.B., Sosnin D.Y.
Abstract

Objective. The aim of the study was to investigate the effectiveness of the preparation of thioctic acid combined with standard therapy among patients with angiodistonic syndrome and vegetative-sensory polyneuropathy of the extremities due to the influence of general vibration.

Materials and methods. A prospective randomized study of two groups of patients with vibration disease was conducted: the main group (n = 30) and the comparison group (n = 30). All patients received standard therapy, while the main group received additional therapy with octolipen (300 mg per os 2 times a day).

Results. The results of questionnaires and objective examination of patients did not establish the occurrence of any side effects when including the drug in the therapy. The survey data proved statistically significant differences in the assessment of pain syndrome at rest and in the occurrence of night pains (p = 0.022). At the same time, when assessing the severity of paresthesia, no statistically significant difference was found between the groups (p = 0.5536). The therapy was accompanied by normalization of the antioxidant status (AOS) in both groups: in the main group, the median AOS increased by 1.342 times and in the comparison group – by 1.267 times. In the statistical evaluation, the inclusion of thioctic acid in the treatment was accompanied by a statistically significant increase in the AOS not only with the initial data (p < 0.00001), but also in comparison with the results of treatment of patients in the comparison group (p = 0.0387). The data from the reovasographic study also showed that the therapy was more effective with additional inclusion of thioctic acid drug to it.

Conclusions. Thus, the data obtained justify the feasibility and effectiveness of using thioctic acid preparation in the treatment of angiodistonia and polyneuropathy syndromes.

Perm Medical Journal. 2020;37(4):17-25
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NT-proBNP content in seminal plasma of ejaculate in normal conditions and in oligozooastenospermia
Sosnin D.Y., Galkovich K.R., Krivtsov A.V.
Abstract

Objective. To investigate the NT-proBNP concentration in ejaculate samples from healthy men and men with oligozooastenospermia.

Materials and methods. The study included 52 men of reproductive age (34.4 ± 3.9 years). The main group (n = 18) consisted of men with reduced ejaculate fertility, the comparison group (n = 34) consisted of men with normal levels of concentration and total sperm count. In seminal plasma, the concentration of NT-proBNP was investigated by solid-phase ELISA using the NT-proBNP-ELISA-BEST test system (A-9102) (Vector-Best, Russia).

Results. The mean value of NT-proBNP content in the ejaculate (n = 52) was 29.498 pg / ml, the median concentration was 2.860 pg / ml and was characterized by high variability. In 62% (32 of 52) of the tested seminal plasma samples, the NT-proBNP value was below 20 pg / ml. The frequency of samples with such a low NT-proBNP content did not differ statistically significantly between the groups. In the main group, the number of such samples was 44 % (8 samples out of 18), and in the comparison group, 65 % (12 samples out of 34).

Conclusions. When comparing the content of NT-proBNP in seminal plasma, no statistically significant differences were found between the groups. An analysis of the correlation between the concentration and the number of sperm in the ejaculate and the NT-proBNP content also did not reveal a statistically significant relationship. The possible role of natriuretic peptides in human fertility is discussed.

Perm Medical Journal. 2020;37(4):26-35
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Role of vasculoendothelial growth factor and its gene in pathogenesis of hepatobiliary pathology
Schekotova A.P., Bulatova I.A.
Abstract

Objective. To assess the pathogenetic value of vasculoendothelial growth factor (VEGF) and polymorphism of its gene in hepatobiliary pathology.

Materials and methods. The study included 190 patients with hepatobiliary pathology (HBP): 100 patients with chronic hepatitis C (CHC) in the reactivation phase, 50 – with HC in the outcome of CHC, 30 – with cholelithiasis, 10 – with focal liver lesions (including 8 with primary and secondary liver tumors).

Results. In case of hepatobiliary pathology, VEGF, as indicator neoangiogenesis and endothelial dysfunction (ED), is a marker of the severity of liver lesion: its production is increased in some patients with cholelithiasis, moderately elevated in all patients with CH and significantly elevated against the background of HC and liver pathology of the tumor genesis. In chronic diffuse diseases of the liver, there are detected multiple reliable relationships between VEGF and a number of ED indices, hepatic clinical and biochemical syndromes, liver fibrosis markers, viral load level that proves the obligate involvement of VEGF in the development and progression of liver pathology. VEGF can be used as a test for differential diagnosis of fibrosis in CH and HC with the sensibility of 90 % and specificity of 78 %. Carriage of the allele C in the locus of the VEGF gene (G-634C) in the form of homozygote CC can show the risk of more severe lesion of the liver in CHC and is interconnected with increased production of VEGF.

Conclusions. Vasculoendothelial growth factor and polymorphism of its gene is involved in the pathogenesis of hepatobiliary pathology, activating neoangiogenesis and fibrosis in the liver.

Perm Medical Journal. 2020;37(4):36-45
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Lyme borreliosis: clinical and epidemiological features of its course in the territory of large industrial center of Western Urals
Nikolenko V.V., Vorobyova N.N., Merkuryeva E.V., Nikolenko A.V., Suslina O.A.
Abstract

Objective. Since the territory of the Western Urals is widely known for its high morbidity and mortality rates associated with tick-borne infections, including ixodic tick-borne borreliosis, the study was aimed at estimation of the role of specific prevention in the prevalence of ITB.

Materials and methods. A continuous retrospective clinical and laboratory analysis of 1214 adult patients admitted to Perm Regional Clinical Infectious Disease Hospital with lyme - borreliosis in 2012-2019 was carried out.

Results. The disease is registered more often in persons over 50 years old, infection mainly occurs while visiting forests and park zones that requires the use of means of protection to reduce the number of the carriers of infection. Every third patient has mixed infection, where pathogens circulating in the ticks of the given territory of the Western Urals are combined. The increase in the number of non-erythemic forms in the recent years is probably associated with the development of immunodeficiency in the population of the industrial center, as well as with the use of more sensitive and informative methods of laboratory diagnostics.

Conclusions. Specific prophylaxis is highly effective, helping to prevent infection in more than 90% of cases.

Perm Medical Journal. 2020;37(4):46-53
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Use of thermal imager in complex diagnosis and treatment of musculoskeletal system diseases: literature review
Vinderlikh M.E., Schekolova N.B.
Abstract

The experience of using thermal imager in diagnosis and treatment of musculoskeletal system diseases based on review of domestic and foreign literature is presented in the paper. Bibliographical method was applied. A short history of using thermovision in foreign and domestic practice is considered, the problem aspects of the offered technology are accentuated, the use of thermal imager in diagnosis and treatment of musculoskeletal system diseases is analyzed. The possible prospects for development of thermovision in domestic medical practice are determined.

Perm Medical Journal. 2020;37(4):54-61
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Review of literature
Prevention of nosocomial pneumonia in conditions of resuscitation and intensive care unit: literature review
Panacheva L.A.
Abstract

The article presents a review of literature on the prevention of nosocomial pneumonia (NP), which has a high frequency in the resuscitation and intensive care unit, severe complications (up to 52.1 % of cases) and mortality. The following aspects are shown: risk factors for NP and multiple antimicrobial resistance; the goal and program of NP prevention aimed at reducing the likelihood of contamination and infection of patients; the need for epidemiological surveillance of health care associated infections and observance of principles of asepsis and antiseptics by medical personnel; the prevention of oropharyngeal colonization and aspiration; methods of timely verticalization of patients who suffered from acute cerebral insufficiency of any etiology; stimulating spirometry, respiratory gymnastics and chest massage.

Perm Medical Journal. 2020;37(4):62-70
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Physical activity in pregnancy: literature review
Prokhorova O.V., Olina A.A.
Abstract

The paper considers modern ideas on prenatal physical activity, presents an analysis of the effects of systematic physical exercises on pregnancy, childbirth and the postpartum period, as well as on the psychological state of puerperas. The existing recommendations of the international professional communities on the issues of physical activity of pregnant women are highlighted and analyzed. The basic conditions, indications and contraindications for exercise at different gestational periods are outlined. Understanding of the benefits of adequate motor activity during pregnancy and their proper use is associated with an increase in the proportion of favorable obstetric and perinatal outcomes.

Perm Medical Journal. 2020;37(4):71-84
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Methods of diagnosis and technologies
Informative significance of morphological methods for diagnosis of tumor processes
Bulatova I.A., Paducheva S.V.
Abstract

Objective. To assess the comparability of the cytological and histological studies of material of different localizations.

Materials and methods. The work is based on the analysis of results of cytological and histological studies in 48 patients examined at Perm Regional Oncological Dispensary in 2019.

Results. It was established that out of 22 mammary punctates, diagnosis of “cancer” was confirmed in 20 patients with coincidence validity criterion of 91 %. Out of 14 preparations of skin, 13 cases were histologically confirmed that constituted 92.8 %. When studying the lymph node punctate, one mismatch was detected. Out of 6 thyroid punctates, there were 5 confirmed ones. Percentage of false-positive cytological conclusions was on average 7 %, false-negative – 1 %.

Conclusions. Comparability of cytological and histological studies according to the results of data analysis ranged from 50 to 100 % depending on localization and was on average 91.6 %.

Perm Medical Journal. 2020;37(4):85-90
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Bionic ear prosthesis: the coming future
Arutyunov S.D., Stepanov A.G., Elovikov A.M., Arutyunov A.S., Yuzhakov A.A., Freiman V.I., Polyakov D.I., Astashina N.B.
Abstract

Objective. To develop the bionic ear prosthesis design and a method for its manufacture based on intellectual and medical 3D technologies.

Materials and methods. Taking into account the analysis of data from domestic and foreign literature, a bionic ear prosthesis and a device for its manufacture have been developed. During the implementation of the project, digital equipment and software were used.

The developed design of a bionic ear prosthesis consists of several components, including an auricle prosthesis and a sound processor inserted into it. This provides the functionality of remote control, configuration and wireless charging. The system is based on the principle of bone conduction. The auricle prosthesis is an external attachment device with high aesthetic characteristics, made of biocompatible materials using modern digital technologies. Built-in hearing aid, includes a microphone; a sound processor based on a digital signal component with built-in analog-to-digital and digital-to-analog converters; Bluetooth radio channel module for communication with the settings control device (Android smartphone); and an emitter of sound vibrations.

Results. The expected positive effect is to increase the effectiveness of treatment, rehabilitation and socialization of deaf and hard of hearing patients by reducing the volume of surgical intervention; prevention of postoperative complications; the use of a rational aesthetic design of the auricle epithesis made of biologically compatible materials, with an inclinated highly functional electronic hearing aid integrated with the patient's auditory environment.

Conclusions. The combination of these factors can provide a significant reduction in the terms of medical and social rehabilitation of patients of different ages. In addition to the above, a significant advantage of the developed design of a bionic prosthesis and the method of its manufacture is ease of use and economic availability.

Perm Medical Journal. 2020;37(4):91-100
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Preventive and social medicine
Dynamics of medical aid appealability rate among child population in the republic of Sakha (Yakutia)
Bosikova V.I., Burtseva T.E., Douglas N.I.
Abstract

Objective. To analyze the incidence rate in child population of the Republic of Sakha (Yakutia) according to the data of treatment and prevention institutions.

Materials and methods. The article presents an analysis of the incidence rate in child population of the Republic of Sakha (Yakutia) according to the data of treatment and prevention institutions for 2017–2019 including the data of Yakut Republican Medical Information and Analytical Center.

Results. The primary and general morbidity of children and adolescents in the Republic of Sakha (Yakutia) for the period 2017–2019 was analyzed. The morbidity rate in the republic regarding the disease classes and regions is described, and the increase and decrease rates are calculated. According to the analysis results, there is noted an increase in the general and primary morbidity of the child and adolescent population. In the context of regions of the Republic of Sakha, the highest incidence rate in child population was registered in Srednekolymsky, Allaikhovsky, Ust-Yansky, Oleneksky, and Tattinsky regions.

Conclusions. The increase in the general and primary morbidity among the child population and the heterogeneity of these indices in the regions of the Republic of Sakha (Yakutia) requires the implementation of regional and Federal programs to improve primary and specialized medical care in the region.

Perm Medical Journal. 2020;37(4):101-108
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Scientometric analysis of dissertation papers for the specialty "Occupational health" by example of industry branch studies
Shigan E.E.
Abstract

Objective. Over the past time, more and more importance has been attached to the analysis of scientometric indicators of a particular scientific discipline, occupational health is no exception.

Materials and methods. A special place is given to the analysis of indicators of occupational health and safety in the workplace.

Results. The largest percentage of research is based on the study of the worker`s health in the mining, chemical and oil refining industries, metallurgy and mechanical engineering. During the same period, the share of dissertations dealing with the influence of production factors in agriculture decreased significantly.

Conclusion. This problem is not studied enough among knowledge workers, medical personnel, military personnel, employees of potentially dangerous facilities, workers of "peaceful" professions – builders, transport. Representatives of other studied professional groups, including research on the development of occupational health of vocalists, migrants, athletes, as well as workers related to small and medium-sized enterprises, are also found, but in isolated studies, although the problems of prevention, diagnosis, treatment and rehabilitation of occupational health disorders in these categories of workers are relevant, both in this country and abroad, especially in terms of the growing pace of world labor migration.

Perm Medical Journal. 2020;37(4):109-114
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Biology and experimental medicine
Studying of analgesic and anti-inflammatory activity of 2,4-dioxobutanoic acid hydrazine derivatives
Pulina N.A., Kuznecov A.S., Chashchina S.V.
Abstract

Objective. To study the analgesic and anti-inflammatory activity of water-soluble hydrazine derivatives of 2,4-dioxobutanoic acids, as well as to determine the relationship between the structure of substances and their biological effects.

Materials and methods. The laboratory synthesis methods were applied to obtain 2-hydrazine derivatives of 2,4-dioxobutanoic acids. The compounds were tested for biological activity using a hot plate test in mice and an acute inflammatory reaction caused by carrageenan-induced paw edema in rats.

Results. The analgesic activity of four compounds is comparable to that of nimesulide. One of the substances obtained is found to exhibit higher anti-inflammatory activity than nimesulide during the 1st and 3rd hours of the experiment. Two compounds with a combination of high analgesic and anti-inflammatory activity were identified. The effect of certain radicals in the structure of the substances on the activities studied was discovered.

Conclusions. The revealed relationship between the structure of original compounds and their biological activities can be used in the further synthesis and search for new domestic pharmaceutical substances with investigated effects.

Perm Medical Journal. 2020;37(4):115-119
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